Why do Punctal Plugs not work anyone??

[untkicker29]

After reading about almost everyones experience with plugs on this site, it seems like there is a very very low success rate with them. Why is this? Are punctal plugs less effective with lasik patients because the nerves are damaged on the eye?
This has just been something that has bewildered me because I have heard of them benefitting some people, but maybe they only truly benefit a the very mild dry eye sufferer. I have even read that all symptoms dissapear with punctal plugs.

[Rebecca Petris]

After reading about almost everyones experience with plugs on this site, it seems like there is a very very low success rate with them. Why is this? Are punctal plugs less effective with lasik patients because the nerves are damaged on the eye?
This has just been something that has bewildered me because I have heard of them benefitting some people, but maybe they only truly benefit a the very mild dry eye sufferer. I have even read that all symptoms dissapear with punctal plugs.

I know lots of people who appear to benefit from punctal plugs.

Punctal plugs are probably most beneficial to the "true" dry eye patient - where aqueous deficiency is the only issue, not clouded by allergy eyes, MGD, blepharitis, goblet cell damage, etc etc.

It's hard to get a sense of the real success rates of anything on a site like this because almost by definition a significant proportion of the members will be those for whom the common solutions don't work (since they are the most motivated to go research things for themsleves).

Having said all that, the more I hear about punctal plug problems (ranging from cost to unreliability to infections and other problems) the more concerned I get.

One lady I spoke with recently had plugs inserted. Goodness knows where they went in, but somehow her doc was convinced they had fallen out, so he cauterised her. The plugs were still there, however, and one of them even worked its way out somewhere in her upper lid. She has since had four surgeries to try to repair things but she's got permanent damage to her lacrimal system as a result.

Not trying to scare people here. I think the message is just that plugs should not be treated casually ("here, let me slip these in and you'll be all better") and, perhaps, despite the increased discomfort and risk of plugs falling out, there's a lot to be said for the ones with caps that sit on top and can be seen versus plugs that get shoved way down in the cannalicula. At least those ones don't get "lost".

[Judy M.]

Punctal Plugs

I had them put in once by a local ophthalmologist. She said they should clear up my problem (dry eye). NOT! When I finally took myself to the "big city" where the pros are, the examination they did showed that not only did they not help, but that they were gone. I was told that it's not uncommon for them to fall out. I guess the question is, why bother?

[Chris]

I really couldn't survive without my plugs - and I have Herricks, the ones you can't see.

I'm cauterized in the left eye on only the bottom, and I have two Herrick plugs in my right eye. The plugs have been there for 3 1/2 years.

Regular plugs irritate the surface of my eye. If my Herricks fall out, I'll put more Herricks in. If that fails, then I'll get cauterized.

Plugs have given me the most relief compared with anything else.

Chris

[spaniel]

chris- May I ask you if you see any down side to the cauerization?

[Erik]

I got rid of my plugs after about 6 months (point extruding thing scratched my eyes when I looked way to one side, like when changing lanes) and had the doc cauterize my lowers. My uppers ducts are as God made them.

I really like the lower cautery because, although I'm not convinced that they result in my cornea being any wetter (my upper ducts seem very capable of draining the tears), I DO notice that drops stay in a bit longer with the lowers plugged. Late at night, if I have to pound away on the computer, I can do refresh plus every 5-10 minutes (as opposed to every few seconds, which was the case prior to the plugs/cautery).

One point, though: before being cauterized (even partially, but especially in all fours), make sure you like it. I hated the two brief periods where I was totally cauterized--constant slosh of fluids in the lower portion of my eyeballs which made it hard to read (which I have to do a lot) and the extra low-osmotic fluid caused my corneas to swell a bit, which gave me a woozy, looking-through-antique-glass) kind of a feeling. If you have only the bottoms cauterize, make sure they check that the tops function effectively first.

My 0.02.

[Chris]

I've been happy with my lower duct cauterization in my left eye. I had a Herrick (intraoccular) plug in that eye for about two years, then decided to cauterize it. It's been perfectly fine.

I will probably cauterize my right ducts at some point, but I'm happy with my intraoccular plugs in that eye.

Chris

[Gogo]

I really couldn't survive without my plugs - and I have Herricks, the ones you can't see.

I'm cauterized in the left eye on only the bottom, and I have two Herrick plugs in my right eye. The plugs have been there for 3 1/2 years.

Regular plugs irritate the surface of my eye. If my Herricks fall out, I'll put more Herricks in. If that fails, then I'll get cauterized.

Plugs have given me the most relief compared with anything else.

Chris

I'm with you Chris. I might try the Smart Plug again. I was in the clinical study for that one. Since it has been approved and my IntelliPort Plug (experimental not approved) seems to be dissolved after three years I would try the Smart Plug again and see the help I get or cauterize. The IntelliPort can't be seen or felt. You check for it as you do the Herrick.

The IntelliPort Plug is a warm gel place in the punctum that comforms to your each individual puntum area. Then solidifies. It acts like cauterization but can be removed. Unfornately, I had a infection in one eye and there were two others across the nation that sent it back to the company for more research. Quite frankly, I don't think it was the plugs problem, it was the damaged tissue in my right eye. My left eye loved it and have had no problems for three years. I do feel it has dissolved though. Temperatures over 104 degrees and oil with gradually dissolve them. Ladies who use cleansing cream will see theirs dissolve sooner than men.